Provider Demographics
NPI:1881812196
Name:WATSON, MIRIAM DEBORAH (PT)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:DEBORAH
Last Name:WATSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:M
Other - Middle Name:D
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:4198 HOBBY HORSE LN
Mailing Address - Street 2:
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-9361
Mailing Address - Country:US
Mailing Address - Phone:918-724-4788
Mailing Address - Fax:918-396-7929
Practice Address - Street 1:4198 HOBBY HORSE LN
Practice Address - Street 2:
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-9361
Practice Address - Country:US
Practice Address - Phone:918-724-4788
Practice Address - Fax:888-284-2781
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT1447174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist